Low Muscle Mass as a Prognostic Factor for Early Postoperative Outcomes in Pediatric Patients Undergoing the Fontan Operation: A Retrospective Cohort Study

Abstract

The impact of low muscle mass on pediatric cardiac patients remains unclear. We investigated the impact of low muscle mass on early postoperative outcomes in patients undergoing the Fontan operation. The electronic medical records of 74 patients (aged <18 years) who underwent the Fontan operation were retrospectively reviewed. The cross-sectional areas of the erector spinae and pectoralis muscles were measured using preoperative chest computed tomography (CT), normalized to the body surface area, and combined to obtain the total skeletal muscle index (TSMI). Low muscle mass was defined as a TSMI value lower than the median TSMI for the second quintile. The incidence of major postoperative complications was higher in patients with low muscle mass than in those with high muscle mass (48% (15/31) versus 14% (6/43); P = 0.003). Multivariable analyses revealed that a higher TSMI was associated with a lower likelihood of an increased duration of intensive care unit (>5 days) and hospital stay (>14 days) (odds ratio (OR) 0.86; 95% confidence interval (CI) 0.77–0.96; P = 0.006 and OR 0.92; 95% CI 0.85–0.99; P = 0.035 per 1 cm2/m2 increase in TSMI) and incidence of major postoperative complications (OR 0.90; 95% CI 0.82–0.99; P = 0.039 per 1 cm2/m2 increase in TSMI). Preoperative low muscle mass was associated with poor early postoperative outcomes in pediatric patients undergoing the Fontan operation.

Low psoas muscle index as an unfavorable factor in children with end‐stage liver disease undergoing liver transplantation

“…We were unable to demonstrate the PMI of healthy children as controls. A previous study also used the mean PMI of the study population to define low muscle mass 30 . The reported references of PMSA z ‐score in the pediatric population 16,19 were mainly noted in children older than 1 year.…”

Association of Paraspinal Muscle Measurements on Chest Computed Tomography With Clinical Outcomes in Patients With Severe Coronavirus Disease 2019

“…The CT scans used for paraspinal muscle measurement were carried out as part of the assessment of disease severity. Unenhanced axial CT images of patients at the T12 level were selected and assessed by two trained observers who were blinded to the clinical outcomes, using the Chest Imaging Platform plug-in in 3D Slicer software (version 4.8.1, Boston, MA, USA), which enables paraspinal muscles (including the erector spinae and multifidus muscles) demarcation using specific Hounsfield unit (HU) thresholds [16,17]. Skeletal muscle is identified and quantified by HU thresholds of -29 to +150.…”

Prediction of whole body composition utilizing cross-sectional abdominal imaging in pediatrics

“…In adult cancers, sarcopenia and sarcopenic obesity have been strongly associated with toxicity and inferior survival outcomes across many histologic types and stages [5,34]. Assessment of sarcopenia in pediatrics has been limited to small studies utilizing a range of surrogate markers including psoas muscle area or skeletal muscle index at lumbar vertebral levels, paraspinal muscle areas or intramuscular adipose tissue [8, 9,35]. Among pediatric cancer patients, differences in body composition may be important prognostic factors for both morbidity, mortality and drug-related toxicity [36,37].…”

“…visceral obesity, sarcopenia, sarcopenic obesity) is an important and well-established predictor of morbidity and mortality across a spectrum of adult cancers [5]. Increasingly, sarcopenia has been associated with treatment-related morbidity and mortality among children with different chronic diseases, including cancer [6][7][8][9][10].…”